Ontario’s COVID-19 cases have been on the decline. What can we expect if there’s a 2nd wave?

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With summer almost over and Ontario continuing into Stage 3 of its reopening strategy amid the novel coronavirus pandemic, many are worried — and wondering — about the possibility of a second wave of COVID-19.

Over the summer months, Ontario’s coronavirus numbers have trended downward, but once the cold weather sets in, experts say that could change.

Read more: Canadians fear 2nd wave of COVID-19, increasingly wearing face masks, poll finds

A large part of that has to do with people spending more time indoors, where the virus is more easily transmitted, and experts say spaces where people are able to congregate pose a risk — one that must be appropriately managed in order for businesses and other institutions to remain open.

“We did experience a first wave, which has subsided,” Dr. Susy Hota, an infectious disease specialist and the medical director of infection prevention and control at the University Health Network, told Global News.

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“We’re kind of in that period of in-between that initial wave and the potential for additional waves.”

What happens moving forward, Hota said, is dependent on everybody’s actions — including maintaining physical distancing and social bubbles, wearing masks and handwashing frequently.

If people, businesses and institutions adhere to these principles successfully, and government and public health bodies facilitate good access to testing, contact tracing and early detection systems, then Ontario could do OK with COVID-19 in the future, according to Dr. Isaac Bogoch, an infectious disease specialist at Toronto General Hospital.

Dr. Zain Chagla, an associate professor of medicine at McMaster University and an infectious disease physician at St. Joseph’s Healthcare in Hamilton, thinks there will be an increase in COVID-19 cases as the cold weather settles in.

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Part of this, he said, has to do with the fact that the spread of other respiratory viruses is typically worse during that time period, with it being particularly bad in December, January and February.

Read more: A 2nd wave of COVID-19 is possible. Here’s what that means for Canada

But while there’s a possibility for a second COVID-19 wave during the colder months, Hota isn’t convinced that it would necessarily be worse than Ontario’s first wave.

“I think what’s going to be more complicated, if we do experience a second wave in the fall, is the fact that it’s going to be happening at the same time as we have other respiratory viruses commonly circulating,” she said.

“Those symptoms look very similar to the symptoms of COVID-19, and it’s not possible clinically to separate out the two, so how do we develop a good strategy to manage all of this?”

Another potential problem is the number of people who could end up in the hospital due to the flu circulating during the colder months, which could put greater strain on Ontario’s health-care system, according to Dr. Robyn Lee, an assistant professor of epidemiology at the University of Toronto’s Dalla Lana School of Public Health.

“Historically, the second wave was worse for the Spanish flu,” Lee said. “We’re going to try and prevent that from happening, but that does require capitalizing on all the things that have been built up, like trying to keep test capacity at a high.”

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It also helps to look at how other countries that have been relatively successful with controlling the spread of COVID-19 have fared when it comes to reopening their economies, according to Bogoch.

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“Places like Germany, Japan, Australia, New Zealand, Singapore — all these places have had to reimpose public health restrictions to some extent as they’ve opened up their economies,” he said.

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“I don’t think we’re going to be any different. I wouldn’t be surprised if there’s some parts of Canada that have to reimpose public health restrictions just because there’s an unacceptable number of new cases per day.”

Some businesses that have been allowed to open during Ontario’s Stage 3 have been a source of concern for people, including bars, indoor dining at restaurants, gyms and movie theatres.

“There’s variability within these businesses as to how well they can actually adapt the way the business is run so that it can be safer,” Hota said.

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“We’re balancing different risks, so there’s a safety and health risk with COVID-19 transmission, and then there’s an economic risk, and that also has safety and health implications.”

What’s more concerning, Bogoch said, is complacency settling in among people, social bubbles starting to grow and people starting to become “tired” of the pandemic.

Read more: South Korea has entered its 2nd wave of coronavirus. What can Canada learn?

“British Columbia, for example, is, unfortunately, having a rather large number of new cases per day,” he said.

“There’s a lot of drivers for that, and one of many of those drivers is they’ve had some well-known outbreaks associated with house parties or people in their 20s or 30s getting together.”

Lee thinks Ontario could have waited to reopen bars, saying allowing them to reopen could cause people to believe that things are operating normally, as they were pre-pandemic.

“While there are those distancing requirements and you’re not supposed to go between tables, when people drink, sometimes they’re not as aware of the distance or not as aware of hand hygiene,” she said.

But closing bars down could bring on its own set of challenges, according to Bogoch, including driving gatherings underground, which makes it difficult to contact trace if there’s COVID-19 spread or exposure.

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“Often the harm reduction approach is the best approach,” he said.

Read more: 2nd coronavirus wave in U.S. hits plateau, but future still uncertain

Other concerns with a potential second COVID-19 wave are the virus’s effects on Ontario’s more “vulnerable” populations — for example, long-term care residents, homeless people and Indigenous communities.

“If there’s a second wave, it’s really the elderly that I’m concerned about but also remote, isolated communities that can’t get out in an adequate period of time,” said Dr. Anna Banerji, an associate professor of pediatrics at the University of Toronto’s Dalla Lana School of Public Health.

“If it gets into some (Indigenous) communities and there’s overcrowding there, then I think that’s also an area where there could be a major impact.”

In an email to Global News Friday, Ontario Ministry of Health spokesperson Anna Miller said First Nations have been working with Ontario Health to make sure that they have geographical and culturally-safe access to testing, which has involved a number of approaches, including setting up Indigenous-specific assessment centres.

“Ontario Health is working with communities to proactively provide access to testing remote, isolated, rural and Indigenous communities,” Miller said.

“The province has put expedited processes in place for northern and remote communities to reduce turnaround times for the processing of lab samples through logistical support flights.”

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Read more: Indigenous people need more support to weather 2nd wave of COVID-19: experts

According to Miller, the province is also responding to First Nations’ and Indigenous health-care providers’ personal protective equipment (PPE) needs.

When it comes to long-term care, Hota said Ontario needs to make sure the sector doesn’t end up in the same place it did during the first coronavirus wave.

In May, a startling report released by the Canadian Armed Forces found some long-term care homes in Ontario didn’t have proper infection control measures in place, with residents experiencing neglect and abuse.

The government responded by launching inspections, appointing temporary management at the homes, and providing emergency funding, staffing support and expanded testing, among other measures.

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“Long-term care is a huge priority for our government and every option is on the table to protect residents and staff from COVID-19,” Ontario Ministry of Long-Term Care spokesperson Gillian Sloggett said in an email.

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“We will continue to follow the direction of the chief medical officer of (health) to protect residents and staff as this virus evolves and if Ontario experiences a second wave.”

Looking at the fall months, Lee said the turnaround time for testing needs to be improved, as does the number of people doing contact tracing.

I think that’s going to be very critical,” she said. 

Other concerns for the colder season surround the reopening of schools and stockpiling enough PPE for health-care providers, according to Banerji.

“I would hope that we learned and have enough equipment and resources to handle a second wave, but I don’t know,” she said.

Read more: Canada reviewing its coronavirus aid to prepare for possible 2nd wave, Trudeau says

Bogoch agrees, saying Ontario is probably “pretty close” to being prepared for a second COVID-19 wave, although he’s not sure the province is ready yet.

“Fortunately, we have a bit of a gift of time,” he said. “We still have pretty low case numbers in Ontario right now.”

Ontario Premier Doug Ford has said the province has a plan to tackle a possible second wave of COVID-19 in the fall.

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To prepare for the colder months, Miller said Ontario’s ministry of health is building a plan that will “leverage and optimize capacity across all sectors.” She noted the ministry will spend $594 million in the hospital sector in 2020 to 2021.

“Should a second wave arrive, Ontario will continue to be able to increase critical care capacity in the same way it has done during this first wave,” Miller said, adding the province will continue to use its critical care COVID-19 command centre, which monitors needs across Ontario and helps to move resources as needed.

“The command centre has been — and will continue to be — able to respond promptly to predicted and unpredicted surges in demand.”

According to Miller, the government is also expanding testing capacity, increasing case and contact management and securing the necessary PPE to respond to COVID-19.

“The chief medical officer of health and other public health experts will continue to closely monitor the evolving situation to advise if and when public health restrictions can be further eased or if they need to be tightened or reapplied,” Miller said.

— With files from The Canadian Press

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